Individual
DIVYA BANSAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8988 LORTON STATION BLVD, SUITE 202, LORTON, VA 22079-4758
(703) 372-2280
(703) 372-2024
Mailing address
224-D CORNWALL STREET NW, SUITE 204, SUITE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(703) 372-2024
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110004272
VA
363A00000X
Physician Assistant
PA031036
DC
363AS0400X
Surgical Physician Assistant
0110-004272
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407295215
—
VA
05
—
30016833620001
—
VA
Enumeration date
06/14/2013
Last updated
03/06/2024
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